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04 March 2009
Mental Health Specialist Discusses Helping Survivors of Torture
CO.NX webchat transcript, March 3
Mental health professional David Alan Harris discussed how to help victims of abuse, torture and war trauma in a March 3 CO.NX webchat. In his work, Harris promotes sustainable solutions to the problems of refugees and asylum-seekers.
Following is the transcript:
(begin transcript)
U.S. DEPARTMENT OF STATE
Bureau of International Information Programs
Webchat Transcript
Guest: David Alan Harris
Date: March 3, 2009
Time: 11 a.m. EST (16:00 GMT)
Webchat Moderator (Mark): Please join us on March 3 at 16:00 GMT as we discuss how to help torture survivors with expert David Alan Harris. We are taking your questions now.
Webchat Moderator (Sarah): Hi everyone - welcome to the webchat. Mr. Harris will be answering questions in about 50 minutes.
Webchat Moderator (Marie): Hello everyone. We'll be getting started in about 10 minutes. Welcome everyone. We're just about to get started. My name is Marie and I'm joining you from Washington DC. Feel free to introduce yourself and tell us where you're from.
Mr. Harris has just joined us. We'll be starting in just one moment. Thanks for your patience.
David Alan Harris: Hello. It is an honor to be able to chat with you about torture and recovery from such terrible suffering. I would be happy to answer questions not only regarding treatment itself, but about your own self-care, as you work with survivors. Thank you for joining me for this discussion.
Question [mukeshwilliams]: There are two things that need to be addressed in torture survivors, strategies to overcome psychological trauma and a rationale to overcome injustice. Which of the two is more difficult to address and what methodology we should adopt for each?
Answer [David Alan Harris]: It is hard to separate psychological intervention from intervention at the level of justice in human interactions. Some mental health professionals working with survivors of torture have devised forms of intervention for enhancing clients’ sense of power, at once personal and sociopolitical.
David Alan Harris: In the context of the reign of terror that was Pinochet’s totalitarian regime, for example, Cienfuegos and Monelli (1983) transformed the psychoanalytic model of communication, internalization, and catharsis into a form of “testimony” that facilitated reconstructing their clients’ autonomy and sense of self-esteem. In their therapy with torture survivors and the families of the disappeared in Chile, the two authors engaged their patients to record on audiotape their memories of abuse, and to join with the therapist in revising the recorded text into a written document that might be shared for political purposes.
David Alan Harris: This practice was found effective in enhancing the survivors’ integration of the extreme, disabling exposures they had experienced, and afforded some clients symptomatic relief. Cienfuegos and Monelli aimed, successfully it appears, “to transform the person’s story about shame and humiliation into a public story about dignity and courage” (p. 79).
David Alan Harris: Becker and colleagues advocate “social reparation,” and a process of “social mourning,” which must be fulfilled if democracy is to prevail in Chile:. . . repair in the psychoanalytic sense must occur at both the individual and social levels, but it can only take place fully if it is linked to reparation in the legal sense—that is, with truth and justice for the victim and compensation where it is helpful. (p. 147)
Cienfuegos, A. J., & Monelli, C. (1983). The testimony of political repression as a therapeutic instrument. American Journal of Orthopsychiatry, 53(1), 43-51.Becker
D., Lira, E., Castillo, M. I., Gomez, E., & Kovalskys, J. (1990). Therapy with victims of political repression in Chile: The challenge of social reparation. Journal of Social Issues, 46(3), 133-149.
Webchat Moderator (Marie): Mr. Harris is now reviewing your many questions. Thanks again for your patience.
Q [Troy]: Hello. The mental scars of torture may be healed but at the end of the day young militants who survived torture or conducted torture still have a bleak life in some African countries...what's to stop the cycle from repeating itself?
A [David Alan Harris]: Successful reintegration requires coordinated effort. I believe that psychosocial intervention needs to be included, along with initiatives that address socioeconomic survival. In post-conflict communities, people from various sectors need to be directly involved in efforts at reconciliation. The momentum needs to come from the people in the communities themselves.
David Alan Harris: INGOs may play a part, particularly in terms of providing resources at the outset, but it is critical that the control of these efforts be in the hands of local people at all levels of society. In Sierra Leone, where I worked, we held community discussions in relation with the work of the Truth & Reconciliation Commission, and this kind of community education and outreach proved very helpful in mending old bitterness.
Q [wdwest]: Do you work with anti-torture organizations within the US...organizations such as the Center for Justice and Accountability in San Francisco?
David Alan Harris: Wdwest, I work with torture treatment organizations in the U.S. and have worked with the IRCT in Europe as well. As far as I know, all these groups are involved in anti-torture work. I have also worked for Human Rights Watch, and I volunteered with Amnesty International's campaign to support the closing of Guantanamo.
Q [wdwest]: Have you been involved in any cases of religious persecution in foreign countries? If so, what countries?
Have you consulted with, or been a witness for the US Government in anti-torture cases? Specifically, either ICE in Operation No Safe Haven or the FBI in pursuing Torture Convention criminal cases?
Q [wdwest]: The Intelligence Reform Act of 2004 expanded the USG's statutory authority against foreign perpetrators of severe violations of religious freedom...quite arguablly linked to torture and human rights abuses...and the State Department issues annual reports against foreign countries so involved. Would you agree that such actions constitute human rights abuse?
A [David Alan Harris]: Wdwest, there is no doubt that severe violations of religious freedom amount to human rights abuse, as they contravene the Intl Declaration of Human Rights, among other international conventions. I have not been directly involved in working with survivors of religious persecution IN other countries, but have worked in the U.S. with clients tortured for their religious beliefs. I am thinking now of an Eritrean family whose religious ideals led them to object publicly to war. I certainly have not represented the USG in the legal sphere. Instead, I have served as an expert witness on torture and PTSD in cases of torture survivors seeking asylum here in the U.S.
Q [amel]: Can torture survivors actually live normal lives?
A [David Alan Harris]: It is exceptionally difficult for survivors of torture to return to lives we would term normal. But with effective care, such healing is well within the realm of the possible. Virtually all of the individuals I have worked with have progressed significantly, given serious effort on their own part and the commitment of a mental health worker who is willing to focus on empowerment.
Judith Lewis Herman, in her book Trauma and Recovery (1992) emphasizes three stages in the recovery process: Safety; Remembrance and mourning; and Reconnection. Torture survivors need first to feel safe again. They need to relearn trust in environments where trust has been taken from them. They need an opportunity to grieve in a culturally-appropriate way over the losses they have suffered. It is useless to deny that there have been losses, as the body itself holds reminders of this suffering.
They need opportunities to reconnect with a community, to function in meaningful roles. This means reintegration into the socioeconomic life of a community, since often family life has been seriously disrupted. My process in working with torture survivors is always to encourage the person to identify what helped her/him to survive. What resources did she have that enabled her to endure horrific pain and loss? For many people, these resources are spiritual in nature. Whatever sorts of resources these may be, it is important to honor them. Doing so helps rebuild trust between the helper and the survivor, and establishes the groundwork from which to begin focusing again on the present and future, and letting the past become the past.
Q [qarabaqi]: Dear Harris, I am a man, who was tortured about 35 years ago in Shah's political prison in Iran. Do you think complete mending will never happen? What about hatred that will remain with those who have been tortured?
A [David Alan Harris]: Dear Friend, The mending of hearts and minds is perhaps a lifelong process. Survivors of torture who have come to live in ways that bring them authentic happiness again would tell you that they have never forgotten the cruelty of those who tortured them. It is not my role to judge hatred of the oppressors as wrong.
In fact, it is my experience that survivors often need permission to express their righteous anger over the horrors they’ve endured at the hands of others. The mental health clinician can work with such individuals to help them find appropriate ways for directing their aggression and feelings of rage. Not to have occasion to express it somehow often means that the rage stays inside the person herself or himself. There is a theory in psychology that depression results frequently from stifling anger that ought rightly to be directed outwards—and instead turning that anger against the self.
I often work with survivors to find physical ways of letting go of held anger. Playing football is the kind of activity that releases aggression in a way that is culturally acceptable. Using our bodies to the point of exhaustion can be a relief. For others uninterested or unable to engage their bodies actively, it is important to find another way to express anger that remains after being harmed so terribly.
Without talking with you and being present with you, it is difficult to know what to suggest in your case. My guess is, though, that by finding an appropriate way to express the anger that you feel over the horrors you endured, you may find yourself in time less preoccupied with hatred. You may, in fact, find yourself more focused on the present and the future than on the past.
Comment [qarabaqi]: When I was under torture in Shah's regime, Human Right Activists from US did a great work to oppose torture in Shah's regime. From that time till now, I have a very good judgment about Democrat party and Human Right organizations. I want to thank you for your activities, and I wish you & Mr. Obama success in eliminating torturer in Guantanamo and everywhere else, inside or outside United States.
Q [James Yee]: It's been confirmed that prisoners at Abu Ghraib, Guantanamo, Baghram and other secret facilities have been abused and mistreated. Would you say some of these individuals have been subjected to torture? Would you say the level of PTSD would be significant in these victims, and what obligations do you think the U.S. has to provide these victims with treatment for PTSD?
A [David Alan Harris]: Mr. Yee, I am very glad that you ask these questions. I have read everything that I could find on the maltreatment of detainees at Abu Ghraib, Guantanamo, and Bagram. From all indications, torture has been widespread in these facilities. Given the severity of the abuses, it seems likely that many of the survivors will have PTSD, and if not, they will have other forms of post-traumatic distress. The USG, like all other governments, is obliged to comply with international human rights conventions, including the Geneva Conventions. I personally believe that reparations must be made. Let me add that I hope that the US soon joins the International Criminal Court. Accountability is a critical element of the healing process, both for individuals and for nations.
Q [mukeshwilliams]: Torture usually damages an individual’s self-esteem and his belief in others. It makes him undergo a near-death experience. Usually such torture survivors are diagnosed as suffering from post-traumatic stress disorder (PTSD) when actually they may be suffering from disorder of extreme stress not otherwise specified (DESNOS). Is there a clear method to diagnose PTSD and DESNOS?
A [David Alan Harris]: Mukeshwilliams: There are various structured interview instruments, often created by individual treatment centers, to help in the diagnosis of PTSD. A good resource for information is the IRCT website: www.irct.org. I worked for the Center for Victims of Torture too. Its website is www.cvt.org. I'm not sure if diagnostic instruments are available online, though.
Comment [James Yee]: Thanks for your answer. I was someone with first hand knowledge of Guantanamo Abuses from my assignment as the chaplain assigned to the prison camp. I think there is an excellent opportunity for the U.S. and President Obama to begin repairing relations with the Muslim world by providing treatment for PTSD and other forms of post-traumatic distress.
Webchat Moderator (Marie): Thank you for your comment.
Q [ANA MARÍA VIVES]: Mr David my name is Ana and I ´m from Argentina. First I would like to congratulate you and your important work. My question is about the child soldiers, special focus in girl child soldiers Today, child soldiers are known to have been used in conflicts throughout Africa and in Colombia, Sri Lanka, Burma, the Philippines, Iran, Iraq and Chechnya, and my ask is about de rehabilitation and reintegration for this victims?. Thank you.
A [David Alan Harris]: Ana, I have an article available now on psychosocial page of the website for the Coalition to Stop the Use of Child Soldiers, an INGO based in London. [www.child-soldiers.org] My article focuses on methods for encouraging the restoration of empathy among child soldiers. This is most easily accomplished in situations where children affected by war have available to them opportunities for both psychosocial support and for securing their futures (in terms of education, skills training, and involvement in community-building activities).
If you have access, I’d encourage you to read a book by Michael Wessells (2006), Child Soldiers: From Violence to Protection, Harvard University Press: Cambridge, MA.
Mike Wessells, whom I’ve studied with, proposes a comprehensive program to combine rehabilitation and reintegration of child soldiers. He focuses on utilizing community-based approaches, such that the direction of a project would be entirely different in Angola than one would be in Colombia. His book has a separate chapter on girl soldiers.
Webchat Moderator (Marie): That is all the time we have today for this webchat. Mr. Harris will be finishing up shortly.
Comment [qarabaqi]: Thank you Mr. Harris. I wish we will see you again.
David Alan Harris: It has been a great pleasure for me to be in conversation with all of you, and I regret that I cannot type fast enough to answer all your questions. Thank you for your time and for asking such important questions. Best wishes with your work, and please be sure to make deliberate plans for taking care of yourselves as you help others who have survived enormous pain and loss. You should know that it is common for caregivers to take on the suffering of those they help. You need strategies for making sure you get adequate sleep, exercise, as well as nutrition. Follow your spiritual practice. Find opportunities for pleasure and recreation. And continue doing good work. Best wishes, David Alan Harris
Webchat Moderator (Sarah): Thank you again to Mr. Harris for chatting with us today and to all of you for joining us. Please visit our Facebook page for information on future chats: http://co-nx.state.gov.
Webchat Moderator (Sarah): The Webchat is now closed. We wish to thank David Alan Harris for joining us today. A transcript of today's webchat will be posted to http://co-nx.state.gov and to http://www.america.gov/multimedia/askamerica.html within one business day. Speakers are chosen for their expertise and may not reflect the views of the U.S. Department of State.
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